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What is a Medicaid Waiver?For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Program Description

Based on the Cash and Counseling model, this program offers qualified, Alabama seniors and disabled individuals the option to select and manage their own care providers. This program is open to Medicaid participants that are currently receiving services under the SAIL Program Waiver or the Elderly and Disabled Waiver.

The Personal Choices program shifts the money designated for services provided under the Medicaid waivers to the participants themselves and allows them to direct their own care services. To be clear, cash payments are not made directly to the participants, but rather to an intermediary financial management agency, and then to care providers of the participants choosing. Participating individuals no longer receive care from Medicaid.

This type of program, in which the consumer directs their own care, is referred to by many names, including participant direction, self-directed care and cash and counseling. Nationally, these programs are growing in popularity in part because they allow certain family members to be paid as personal care givers, as long as they are over 18 years of age and pass a basic screening test.

This program is currently available only in 7 counties of Western Alabama: Bibb, Fayette, Greene, Hale, Lamar, Pickens and Tuscaloosa and 2 counties in Southern Alabama: Baldwin and Mobile.

Eligibility Guidelines

To qualify for the Personal Choices program, individuals must enroll (or be enrolled) in Medicaid and be receiving care under the Sail-Homebound Program Waiver or the Elderly and Disabled Waiver. Under the rules for these waivers, a medical declaration is required that shows the client requires nursing home level care. In addition, there are certain financial requirements.

Income Limits - These change each year. For 2015, individual income cannot exceed $2,199 / month. However, if only one spouse of a married couple is applying, their joint income can be shifted to provide a livable budget for the non-applicant as well as help the applicant to qualify.

Asset Limits - These typically do not change as frequently as the income limit. For the last few years, the limit for a single applicant has been $2,000. However, for 2015, non-applying spouses can retain up to $ 119,220 in assets excluding the value of their home provided it is lived in by the owner(s).

Past Asset Transfer Considerations - This is an important factor. The state will review an applicant's financial transfers as far back as 60 months preceding their application to verify they did not give away assets to qualify for Medicaid.

Exceeding the limits by relatively minor amounts may not rule out qualifying. Planning professionals who specialize in Alabama Medicaid eligibility can help families to reach the state standards by shifting assets and using specially designed trusts. Learn more about how a Medicaid planner may assist.

Benefits and Services

The program pays cash to a Financial Management Service Agency in place of providing services. The Service Agency compensates care providers as determined by an agreed upon plan between the participant and their Personal Choice Program Counselor. Plans can include the following types of care: